AccountId: 011433970860
ContactId: bb0bb05e-a9ca-47d1-91b8-33cada787edb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 345809 ms
Total Talk Time (AGENT): 101806 ms
Total Talk Time (CUSTOMER): 80424 ms
Interruptions: 0
Overall Sentiment: AGENT=1.7, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/02/bb0bb05e-a9ca-47d1-91b8-33cada787edb_20250602T13:26_UTC.wav
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[AGENT][NEUTRAL] And thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, hi, good morning. My name is [PII] and I'm calling the provider office and I'm trying to get a status of a medical claim. Is that possible?
[AGENT][NEUTRAL] Um, yes, sir. I can assist you with claim status. Um, first, could I get your name again and a good callback number just in case we're disconnected?
[CUSTOMER][NEUTRAL] My name is [PII] and the callback number is [PII].
[AGENT][NEUTRAL] OK. Thank you, [PII]. Now I need the policy number, please.
[CUSTOMER][NEUTRAL] Uh the policy number is 02458749.
[AGENT][NEUTRAL] And please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Uh, the patient name is [PII], [PII].
[AGENT][NEUTRAL] Thank you. Now I need the date of service and bill charges on the claim.
[CUSTOMER][NEUTRAL] Uh, the data servicing question is [PII].
[CUSTOMER][NEUTRAL] The total charge will be $17,340.
[AGENT][NEUTRAL] OK. One moment, please.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] Mhm. No problem.
[AGENT][NEUTRAL] OK. Yes, sir. We actually received the claim twice. Um, the first time we received the claim, I'm showing that they denied because according to the primary EOB that was submitted along with the claim, um, the primary insurance didn't cover the charges. And under this policy, if the primary insurance doesn't cover the charges, then as their secondary insurance, we don't cover the charges either. And the claim was resubmitted and um it denied for duplicate for the same reasons.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, the Blue Cross and Blue Shid process the claim and put everything on the patient deductible. Did you have that EOV?
[AGENT][NEUTRAL] Um, let me look at the resubmission. It'll be one moment.
[AGENT][NEUTRAL] OK. Thanks for your patience, sir. Yeah, according to the EOB that we have on file, we're showing that the adjustment reason code was A1, and that's because the claim service denied, according to the explanation of benefits that we have on file. Now, the claim can be resubmitted if you have an updated EOB showing where the charges went to the deductible and the services was not denied. But according to what we're showing on both of these EOBs, um, the primary insurance denied it.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] So you never received the one that has a patient deductible.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] Alright, I'll just gonna resubmit this with the attachment.
[CUSTOMER][NEUTRAL] OK. Uh, there's a way that you can provide me with a reference number and kindly repeat your name again?
[AGENT][NEUTRAL] Um yes, my name is [PII]. Um it's spelled [PII] Last initial is [PII], and my name and today's date is your reference number. Um, is there anything else I can assist you with?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] No, that's it. Thank you so much for your help.
[AGENT][POSITIVE] OK. I thank you, [PII], for calling APL. You have a great rest of your day. Mm bye.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][POSITIVE] Hm, thank you.